Nutrition

In the immediate wake of a natural disaster, feeding and sheltering are two of the major issues that are addressed immediately following evacuation or search and rescue operations. These are core elements of survival and are an important area for government and nongovernmental responders.

In complex humanitarian emergencies, including famine and refugee crises, lack of nutrition is often a critical component. Malnutrition is not an immediate concern in most disasters, however, when a disaster occurs in an area that is already dealing with issues of famine, hunger or access to food/nutrition, it becomes increasingly more important. Complications that arise from malnutrition can contribute to increasing death tolls.

Malnourishment is an imbalance in a person’s intake of nutrients and other dietary elements (either too much or too little). The World Health Organization (WHO) groups malnutrition into three broad groups:

• “undernutrition, which includes wasting (low weight-for-height), stunting (low height-for-age) and underweight (low weight-for-age);
• micronutrient-related malnutrition, which includes micronutrient deficiencies (a lack of important vitamins and minerals) or micronutrient excess; and
• overweight, obesity and diet-related noncommunicable diseases (such as heart disease, stroke, diabetes and some cancers).”

WHO has set a series of global nutrition targets “to improve maternal, infant and young child nutrition” by 2025. Below is a list of goals, as well as key facts and definitions. These are linked to WHO policy briefs on each area.

1. “Achieve a 40% reduction in the number of children under-5 who are stunted: Childhood stunting is one of the most significant impediments to human development, globally affecting approximately 162 million children under the age of 5 years.Stunting, or being too short for one’s age, is defined as a height that is more than two standard deviations below the World Health Organization (WHO) child growth standards median.
2. “Achieve a 50% reduction of anaemia in women of reproductive age: Anaemia impairs health and well being in women and increases the risk of maternal and neonatal adverse outcomes. Anaemia affects half a billion women of reproductive age worldwide.
3. “Achieve a 30% reduction in low birth weight: Low birth weight is defined by the World Health Organization (WHO) as weight at birth less than 2500 g (5.5 lb). Low birth weight continues to be a significant public health problem globally and is associated with a range of both short- and long-term consequences.
4. “Ensure that there is no increase in childhood overweight: There has been a dramatic rise in the numbers of children under 5 years of age who are overweight. According to the new 2013 United Nations Children’s Fund (UNICEF), World Health Organization (WHO) and World Bank estimates (4), between 2000 and 2013, the number of overweight children worldwide increased from 32 million to 42 million. The prevalence of childhood overweight is increasing in all regions of the world, particularly in Africa and Asia.
5. “Increase the rate of exclusive breastfeeding in the first 6 months up to at least 50%: Exclusive breastfeeding – defined as the practice of only giving an infant breast-milk for the first 6 months of life (no other food or water) – has the single largest potential impact on child mortality of any preventive intervention.
6. “Reduce and maintain childhood wasting to less than 5%: The World Health Organization (WHO) classifies wasting in children as severe or moderate, according to the WHO growth reference for weight-for-height. Wasting is a reduction or loss of body weight in relation to height…It is estimated that, at any point in time in the world, 52 million children aged under 5 years are wasted, with 17 million of those estimated to be severely wasted, based on national-level prevalence data.”

When an immune system is weakened by a lack of nutrients from a shortage of food and/or contaminated water, even typically “harmless” illnesses like diarrhea can have devastating effects – especially for children and others whose immune systems are not fully developed or at full strength. According to the Centers for Disease Control and Prevention (CDC), diarrhea kills more than 2,000 children every day – more than AIDS, malaria and measles combined.

While natural disasters do not immediately create malnutrition in populations where that was not a pre-existing concern, they can cause challenges in terms of access to food. The nature of food distribution problems stems from the type of disaster and its impact on transportation systems and community infrastructure. While natural disasters, such as earthquakes, do not usually create too many challenges for nutritional access, floods, tsunamis and hurricanes can dramatically affect food supply and distribution. These kinds of disasters can destroy existing food rations, agriculture crops and livestock, leading to severe shortages. When roads are flooded, or power infrastructure is destroyed, the ability to both access and prepare foods is impacted and the government must distribute safe water and food (or nutritional supplements) to its population. In the 2017 Caribbean hurricanes, food and water distribution to the U.S. Virgin Islands, and especially to Puerto Rico, after Hurricane Maria, was the “longest sustained air mission” in the history of FEMA. When affected populations must rely solely on the distribution of emergency relief rations for extended periods, they miss the full scope of nutrients needed for health.

Unfortunately, the answer is not as simple as just shipping grain to malnourished communities. Though immediate relief efforts—such as external aid being given for the famines in Yemen and the Sudan— significantly help reduce the number of deaths, for those who are seriously malnourished, eating is a physiologically difficult task. Bacteria in the digestive system necessary for processing food may no longer be present. As such, specialized feeding programs are necessary. So too are distribution efforts that do not require parents to bring children to hospitals or infirmaries for food. These trips not only potentially keep a parent from earning income elsewhere, they also put that parent at risk of becoming ill from exposure to others who are sick.

Well-funded research can have a profound effect in disaster preparedness to address nutrition. Consider the development of Plumpy’nut, an edible peanut paste, rich in calories and vitamins. Its use has contributed to bringing children back from severe malnutrition, having been distributed in areas such as Haiti and Africa with noted success. Opportunities still abound for creating innovative, lasting solutions for improving the worldwide picture of nutrition.

• Undernutrition accounts for 45 percent of deaths among children under 5 years of age. Most of these deaths occur in low- and middle-income countries.
• Post-disaster feeding intervention programs should be part of longer-term development strategies that prevent the cycle from continuing. Dependence on external assistance and feeding efforts can keep those living in areas prone to malnutrition from seeking new solutions.
• Even after immediate needs are met, malnutrition can have consequences for generations to come. When women are severely malnourished, they become unable to have children. In addition, chronic malnutrition can affect brain development, potentially diminishing cognitive ability in future years.
• Issues of malnourishment and food insecurity also exist outside the traditional definition of an “emergency.” Consider the pastoralists of rural Africa, nomadic communities constantly in search of appropriate pastures for goats and/or cattle. Settled members of the group—often women and children—regularly suffer from seasonal malnutrition as the herds go to graze. Nutritional supplements and culturally appropriate educational materials could make a significant impact.
• Ongoing nutrition surveillance is essential—especially in vulnerable populations. Disaster preparedness efforts around nutrition should take into account the ongoing specific needs of groups such as the elderly and those with HIV/AIDS or diabetes. Immune systems strengthened by good nutrition are better able to fight illness and disease.

• Ensure disaster response grants incorporate nutrition. The Sphere Project, for example, offers standards for both preventing and correcting malnutrition. Those most at risk for micronutrient deficiencies and diseases include: children under two; women who are pregnant or breastfeeding; older people; and families with chronically ill members. Disasters often exacerbate pre-existing issues.
• Shore up plans to protect vulnerable populations should food supplies decline. Work with established agencies and programs that serve those whose immune systems are compromised by illness and/or age. For example, in the event of a disaster, what is the plan for those with diabetes or HIV/AIDS, who have different nutritional needs than the rest of the general population?
• Invest in educational and public awareness partnerships with local agencies. Partnering with experienced, well-connected individuals on the ground is more effective than simply delivering supplies. Communities invested in their own long-term success will reap greater rewards.
• Foster strategic partnerships to manufacture, distribute and stockpile supplies before a disaster occurs. Work with companies that widely distribute other items to carry food supplies and supplements, and/or encourage local companies to manufacture those supplies. Malnutrition does not occur overnight. As such, preparedness can have a marked effect. Non-perishable items must be available and a plan for getting them to the people most in need must be in place.

• CDP’s 2017 Atlantic Hurricane Season Recovery Fund awarded ASPIRA $300,000 to address food security via three work objectives. They will work to increase the amount of locally grown food, support economic development through tourism activities and develop agriculture and hospitality industry skills in youth ages 12 to 18.
• The fund also awarded Centro de Servicios Primarios de Salud de Patillas Inc. $50,000 to develop an educational program for elderly populations to keep food in good condition during disasters or emergencies with emphasis on securing food, potable water, food storage, reading and interpreting food labels, nutritional and healthy menus, among other food security issues. The program also provides coolers to keep medications safe, water filters, cans of food and bottled water.
• In 2018, the PepsiCo Foundation gave $500,000 to the Salvation Army to provide 350,000 nutritious meals over the course of a year in the wake of Hurricane Florence.
• The California Endowment gave $40,000 to Kern River Valley Revitalization Inc. in 2017 to support community health needs, including nutrition.
• In 2017, Abbot Laboratories Corporate Giving Program gave $600,000 to multiple recipients to support the delivery of nutrition products in the wake of hurricanes Maria and Harvey and earthquakes in Mexico.

• CDP Issue Insights – Famine
• Food Security Information Network – Global Report on Food Crises 2019
• United Nations Office for the Coordination of Humanitarian Affairs (OCHA)
• UNICEF
• World Food Programme
• The Emergency Nutrition Network
• Sphere – Humanitarian Standards
• Famine Early Warning Systems Network (FEWS)

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